Navigating ethical dilemmas in healthcare: Interview with Kyoko Wada

Kyoko Wada joined the Rotman Institue this year as a postdoctoral fellow. She is a trained anesthesiologist with an MA in bioethics from Monash University, Australia and a PhD from Western University. She completed a bioethics research fellowship in the Departments of Psychiatry and Anesthesia & Perioperative Medicine at Schulich School of Medicine and Dentistry, and serves as an ethicist to the Health Sciences Research Ethics Board at Western University, a position she has held since 2010. Based on her interdisciplinary backgrounds, her research involves a wide range of ethical issues in clinical practice and research, such as patient decision-making, risk concepts, and ethics education for healthcare professionals. She sat down recently with Cory Goldstein and Austin Horn for the following interview.

Cory: Tell us a little about your research and your interests, and how they brought you to the Rotman Institute of Philosophy.

Kyoko: My area of research is, broadly speaking, bioethics, healthcare ethics, and research ethics. In these areas, I do conceptual studies as well as empirical studies. For example, my Ph.D. thesis was looking at including pregnant women in clinical research. I did conceptual studies around a risk concept in research regulations and how it might speak to informing clinician’s communication with the patients. My thesis also included an empirical study employing a qualitative approach. I interviewed women, clinicians and basic scientists to find out their perspectives on including pregnant women in clinical research.

For my prospective work at Rotman, I am focused on decision-making of patients with pain. Would they be capable of giving valid consent if they are suffering considerable pain, which is one of the most notorious symptoms? Currently, I am working on a paper on decision-making of labouring women. Can labouring women make an informed decision about whether or not to have epidural analgesia? In writing this conceptual paper, I am reviewing empirical studies on this issue and also theories of decision-making capacity to address this issue.

My future plan is to conduct a qualitative study examining patients’ experience of chronic pain and how they make treatment decisions. The topic of patients with chronic pain intersects with serious issues such as opioid addiction or medical assistance in dying, which are much debated today.

Austin: Your research sounds very interesting, not to mention socially important as well. I suppose my follow up questions are the following: What is your background? Where did you study? And how did you become interested in bioethics?

KW: I was initially trained as an anesthesiologist in the areas of surgical anesthesia, emergency medicine, ICU management, and pain management. In anesthesia, as well as in any areas of medicine, ethical issues are all over the place. Clinicians encounter ethical issues virtually every day. Later, I shifted my practice to palliative medicine and end-of-life care where I encountered more ethical issues. I went on to do a masters course in bioethics in the Centre for Human Bioethics at Monash University, then came to Canada for a two year bioethics fellowship here at Western. After I came to Canada, I got more involved in research ethics, as my then supervisor served as the chair of the University Council on Research Ethics at Western. I presented contentious issues in bioethics at conferences, and also served as an ethicist to the Health Sciences Research Ethics Board (REB) at Western.

AH: What, in particular, attracted you to the Rotman institute? Were there specific people, or resources, that made the Rotman institute seem particularly well-suited to pursue your current research projects and interests?

KW: Given my background, I don’t consider myself a philosopher, neither do I think I have had robust training in philosophy. But, the Rotman Institute is an interesting institute that is open to scholars in interdisciplinary areas, including bioethics. So I didn’t feel I would be a total alien. I have also known Dr. Charles Weijer and Dr. Louis Charland for some time. I decided to work with Dr. Charland as my prospective research concerns the decision-making process of persons suffering from pain. I am hoping to conduct an empirical study with chronic pain patients.

CG: One of the most prominent features of the Rotman Institute is “engaging science,” so it is great to see your plans for empirical work aimed at informing the ethics of decision-making capacity in persons suffering from pain. Could you tell us more about the empirical study and how that will connect to your work with Dr. Charland?

KW: So my empirical research employs the so-called “qualitative approach.” I want to examine how patients with chronic pain make their decisions about treatment options, or about participating in clinical research aimed at pain relief.

I used a qualitative approach in my studies concerning the ethics education for psychiatry residents, and on the stakeholders’ views on including pregnant women in clinical research. In the ethics education piece, I analyzed the reports written by residents. Also, in a study exploring stakeholders’ views about research with pregnant women, I interviewed pregnant women, scientists, and clinicians to obtain data.

Since the research is qualitative, we don’t run software to see whether results are statistically significant. It is more subjective than quantitative approaches, as we work through texts and transcriptions systematically. Usually we start line by line and proceed in an iterative manner, with respect to data collection and analysis, until the researcher feels that no new concepts will emerge from this process.

So back to my prospective study, I am interested in looking at the decision-making process of patients with chronic pain because I assume it must be complex, not simply rational due to on-going pain or, in some patients, opioid addiction. Currently, the standard assessment tool for capacity assessment is the one created by Grisso and Appelbaum, which involves four elements: understanding information, appreciating the information as it applies to oneself, reason by manipulating the information, and then communicate. Prof. Charland has criticized this tool for the little attention given to emotions and values in a person’s decision-making process. And that is why I am working with him. He has previously collaborated with psychiatrists at Oxford to examine decision-making capacity of anorexic patients. So we hope to do a similar study with patients suffering from chronic pain. We hope that by analyzing their decision-making process we may inform or improve upon the procedure for capacity assessment.

I think improving the capacity assessment procedure is critically important because we need to respect persons who are capable and protect those who are incapable. In Canada, the legalization of medical assistance in dying has stirred up debates over many ethical issues. People may eventually be very divisive on this issue, but one good thing due to the controversies is that we are looking more carefully at informed consent, decisional capacity, equal access to healthcare, conscientious objection, public funding for healthcare, etc.

AH: I suppose as a final question I would like to ask if there is anything else that readers of the Rotman Institute blog should know about you, or your research?

KW: No, but I’ll be at the coffee breaks and look forward to chatting with the other members.

CG: Thank you for taking the time to answer our questions, and we look forward to more chats with you in the future.

This is the third interview in our series introducing new postdocs for the 2016-2017 academic year. View previous interviews with Marc Holman and Michael Cuffaro, and check back for more interviews coming soon.